Lee Jong Eun, Koo Hyun Jung, Lee Seung-Ah, Hyun Junho, Yoo Jae Suk, Yang Dong Hyun, Kang Joon-Won, Jung Sung-Ho
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
J Thorac Cardiovasc Surg. 2025 Sep 5. doi: 10.1016/j.jtcvs.2025.08.040.
To evaluate the impact of computed tomography (CT)-guided planning on surgical myectomy outcomes in patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) and/or midcavity obstruction by comparing these outcomes with those of conventional surgical myectomy.
This prospective cohort study included patients who underwent surgical septal myectomy for HCM with LVOT and/or mid-cavity obstruction between January 2019 and May 2024 at a single tertiary center. In the CT-planned myectomy group, an expert radiologist simulated the target myectomy site through a series of postprocessing methods to plan the surgical approach, provide a surgeon's view that closely resembles the actual perspective in the operating room, and determine the target myectomy volume. The conventional myectomy group underwent imaging studies, including echocardiography and cardiac CT; however, surgical planning was done using standard methods without CT-based postprocessing. Baseline clinical findings, surgery-related factors, and clinical outcomes were compared between the 2 groups. Multivariable logistic regression was used to evaluate the impact of preoperative CT planning on clinical outcomes.
A total of 117 patients (median age, 62.2 years; interquartile range, 50.7-69.0 years; 62 women) were included, with 47 (40.2%) in the CT-planned myectomy group. The operation time was shorter in the CT-planned myectomy group compared to the conventional myectomy group (3.8 hours vs 4.3 hours; P = .01). The incidence of left bundle branch block (LBBB) was significantly lower in the CT-planned group (42.6% vs 67.1%; P = .01). No significant differences between the 2 groups were found in major adverse events, including cardiovascular death, complete atrioventricular block, and iatrogenic ventricular septal defects. Multivariable analysis showed that CT-planned myectomy was associated with lower odds of developing postoperative LBBB (odds ratio, 0.32; 95% confidence interval, 0.14-0.70; P = .005).
CT-planned myectomy in patients with obstructive HCM was associated with shorter operation times and a reduced risk of postoperative LBBB compared with conventional myectomy, without an increase in major complications.
通过将肥厚型心肌病（HCM）伴左心室流出道（LVOT）和/或中腔梗阻患者的手术肌切除术结果与传统手术肌切除术的结果进行比较，评估计算机断层扫描（CT）引导的规划对手术肌切除术结果的影响。
这项前瞻性队列研究纳入了2019年1月至2024年5月在一家三级中心接受针对HCM伴LVOT和/或中腔梗阻的室间隔肌切除术的患者。在CT规划肌切除术组中，一名专家放射科医生通过一系列后处理方法模拟目标肌切除术部位，以规划手术入路，提供与手术室实际视角极为相似的外科医生视角，并确定目标肌切除体积。传统肌切除术组进行了包括超声心动图和心脏CT在内的影像学检查；然而，手术规划采用标准方法，未进行基于CT的后处理。比较两组的基线临床发现、手术相关因素和临床结果。采用多变量逻辑回归评估术前CT规划对临床结果的影响。
共纳入117例患者（中位年龄62.2岁；四分位间距50.7 - 69.0岁；62例女性），其中47例（40.2%）在CT规划肌切除术组。与传统肌切除术组相比，CT规划肌切除术组的手术时间更短（3.8小时对4.3小时；P = 0.01）。CT规划组左束支传导阻滞（LBBB）的发生率显著更低（42.6%对67.1%；P = 0.01）。在包括心血管死亡、完全房室传导阻滞和医源性室间隔缺损在内的主要不良事件方面，两组之间未发现显著差异。多变量分析显示，CT规划肌切除术与术后发生LBBB的较低几率相关（优势比，0.32；95%置信区间，0.14 - 0.70；P = 0.005）。
与传统肌切除术相比，梗阻性HCM患者的CT规划肌切除术手术时间更短，术后LBBB风险降低，且未增加主要并发症。
